>These three disorders could really be “CKM syndrome,” which can be treated with drugs like Ozempic
The article is trying so hard not to say that obesity is the cause. I call it the obesity pipeline: You start off young and obese and you don't have diabetes and it's all fine. Stay obese long enough and you get diabetes -> metformin. Stay in a diabetic state long enough and you get heart disease -> statins. These are obesity comorbidities.
There is an alternative possibility: you start out with a metabolic disorder, that will eventually grow into diabetes. Along the way, it will make you obese and cause (directly or indirectly) heart and kidney problems.
Unfortunately, since Ozempic treats diabetes with or without obesity, and it also treats obesity without diabetes, it won't help us figure out if obseisty is a cause or a side effect of diabetes. But there really is little reason to pretend it's clear either way.
History is a pretty strong indication that it’s clear to me.
I find it exceptionally hard to believe populations at scale went from relatively “normal” weights to obese as the majority due to an emerging novel metabolic disorder. All within 1 to 2 generations.
Much simpler explanation is that diets and lifestyles changed leading towards obesity. Whether or not a metabolic disorder happened somewhere in the middle there seems irrelevant to me. It’s very clear to me that obesity causes the issues and not the other way around.
I’m open to thinking differently about it, I just find the evidence uncompelling as someone who was obese the majority of my adult life. Given the unique circumstances of how I grew up and then later experienced life, I’m quite confident obesity is primarily caused by lifestyle. Put simply - put yourself in a situation where obesity becomes easy to achieve and the majority of people will become obese.
Humans being what they are will of course have myriad of outliers to refute the point, but outliers are uninteresting to discuss in this context.
> Amy Bies was recovering in the hospital from injuries inflicted during a car accident in May 2007
When an article starts like this, I instantly close it and wait for proper sources. Anyway, the phrase "metabolic syndrome" has been gaining currency for the last few years. For those who don't want to read journal papers and meta-analyses, there are plenty of doctors and fitness coaches (on YouTube) who have made videos on how to get metabolic syndrome under control or even reverse it. And many of the doctors do a good job of filtering and summarizing the research.
Alongside all of these honest doctors and fitness coaches who espouse metabolic syndrome as the biggest health crisis of the 21st century there is a broad group of scammers and conmen who use the well backed science and literature to seed ground to push supplements and other crap.
They seem to wrap the very basic medical truth of being overweight and inactive is horrific for your health in an onion of pseudoscience bullshit, so you buy the next best product high in "antioxidants" and "polyphenols"
The actual science is unimaginably boring. Do not be overweight on the BMI scale and do some moderate exercise for around 2 hours every week. This will drastically improve the health 1000x more than say the insane stuff that Brian Johnson is touting.
I hate modern fitness influencers and health wellness people in general. My head near about exploded when I saw a Tiktok from Jeff Nippard claiming that eggs increase your testosterone on a study with a sample size of FIVE PEOPLE.
> The actual science is unimaginably boring. Do not be overweight on the BMI scale and do some moderate exercise for around 2 hours every week.
Don't be depressed is also excellent advice for people with depression: if they can manage that, it improves their mood tremendously. Not catching colds also greatly reduces your chances of cold-like symptoms.
By which I mean, what you're saying is a truism, not medical advice. Keeping your BMI under control is a natural no-effort thing for some people, and a grueling lifelong struggle for others. Telling fat people to stop being fat is not "advice", it is exactly as helpful as telling sick people to stop being sick.
Absolutely, the issue of obesity is not just getting people to exercise more I 100% agree. The actual science of having someone diet, exercise and stick to that engagement is literally endlessly complicated and part of the reason why GLP-1 drugs are a big deal they can be given to almost anyone who meet the clinical criteria and see a drastic improvement in overall health and mortality.
That doesn't detach from the reality of the objectives, getting there is difficult for people and there is more research to be done.
FYI: None of my posts are medical advice and I am not a doctor
The term Metabolic Syndrome X has been around for more than a few years, unless nearly 40 is few (and I absolutely relate to that sentiment), just saying that concept was revved up in the 90s and of course has been an academic discussion going back to the early 20th century.
I think they probably mean “article that’s meant to share research but mostly shares anecdotes”. It’s a common framing for this kind of thing though, so they probably have to close a lot of articles after the first sentence.
Someone who wants to tell you something true doesn't lead their communication with emotional distraction. Kinda like how someone who is asking a real question doesn't disguise the question as an insult.
>Someone who wants to tell you something true doesn't lead their communication with emotional distraction.
This seems needlessly cynical. Someone can have multiple objectives in writing, to tell you facts and also to capture your attention or to convey an emotion and motivate you to action. Very little writing is done with a single purpose in mind. We don’t expect academics drafting research papers to eschew concerns about the impact the writing will have on their career for example.
Starting a story with an anecdote that humanizes the information is simply acknowledging the reality that people want more than just facts. If the latter was all they wanted, most of us would only read encyclopedias and textbooks.
In this case it really was just pointless distracting filler. The article would have been better without it. I reach for different books when I want drama or entertainment than when I want data and research. This article promises one thing and then clumsily shoves something else in randomly throughout. It really is obnoxious.
It's not emotional distraction, it establishes the reason the subject was getting blood tests, which is revealed later in the same sentence. If this is your level of reading stamina you must find yourself very poorly informed. Even a tweet would be too long for you.
You will not build reading stamina or make yourself well informed with sappy stories. Learn some basic statistics and try reading research papers directly. "I have read more words" is a measure of only that, and nothing else. Maybe also a measure of the ability to not be able to separate wheat from chaff.
Seems absolutely unnecessary, forced, immeasurably trite, off-puttingly boring, overused, so brazenly cliché that there has to be some kind of counter-intuitive selection going on, like with the email scammers that target those who are not immediately noticing the fraudulent intent.
... or simply our arrogance is showing, after all average minds discuss people, right?
How many major national magazines publish good articles? The inverted pyramid is from newspapers and bears resemblance to scientific publishing while magazines bear more resemblance to the human interest crap between events when presenting the Olympics. Perfectly fine I suppose but then it's nice if they don't get confused about appropriate subjects.
It is all interconnected, but I am unsure about the claim made. The reason is simple: there can be numerous disease types. Person A may have different genetics than Person B, as one example, so responses of a body may be different for that reason alone; then there is lifestyle choice, health, age and so forth. So I don't agree with the claim in the title here that all is one ailment - that makes no sense to me.
We are reasonably confident that diabetes causes heart and kidney disease. However the converse - if I have heart disease (or kidney) I also have diabetes is not true: there are many possible causes of heart or kidney disease.
This logic error is easy to make, and the headlines all too often imply it, but it isn't always true (sometimes it is).
I generally agree. It's all interconnected, and we could point to a singular cause, but to treat them all as one and of the same class of disease seems reductive and not useful.
Though, to be play devil's advocate for a second, it does seem that diabetes is typically where the symptoms start, and we do understand that diabetes is fundamentally metabolic and/or functional dysfunction in 1 or more of 7-ish different areas.
I think it's the level of perspective zoom + timing we take that makes the article's assertion either useful or not.
If we zoom out, while catching disease early on, and we address the metabolic conditions via lifestyle and/or certain drugs like GLP1, then we prevent the need to intervene on the kidney and cardiac front.
But if we zoom in to a specific issue, after disease has progressed a profound amount, a GLP1 intervention may be too little, too late.
Hopefully though, this may help the messaging to folks that if they are contending with metabolic disease that presents as diabetes, introducing lifestyle and pharma interventions early may be helpful on the larger epidemiological front.
There are 90 year olds with 60 years of diabetes and no complications and 40 year olds with 3 years of diabetes and devastating complications. Same for heart and kidney disease. They cannot be put in the same basket. No matter how much they try to push GLP-1's for everything under the sun, they are not.
If they find the drug of immortality, I am sure they will name every disease "partial death".
> The ties are so strong that in 2023 the American Heart Association grouped the conditions under one name: cardio-kidney-metabolic syndrome (CKM), with “metabolic syndrome” referring to diabetes and obesity.
Seems like this is mostly an extension of the previously existing label of metabolic syndrome, now including kidney. Ozempic is mentioned and I take that to mean obesity is the cause. But are some of these ailments like diabetes reversible?
I think it's saying that diabetes (T2 is reliably reversible) causes damage to the heart and kidney but sometimes the connection isn't made and they treat the kidney/heart symptoms without addressing the cause (T2D).
>These three disorders could really be “CKM syndrome,” which can be treated with drugs like Ozempic
The article is trying so hard not to say that obesity is the cause. I call it the obesity pipeline: You start off young and obese and you don't have diabetes and it's all fine. Stay obese long enough and you get diabetes -> metformin. Stay in a diabetic state long enough and you get heart disease -> statins. These are obesity comorbidities.
There is an alternative possibility: you start out with a metabolic disorder, that will eventually grow into diabetes. Along the way, it will make you obese and cause (directly or indirectly) heart and kidney problems.
Unfortunately, since Ozempic treats diabetes with or without obesity, and it also treats obesity without diabetes, it won't help us figure out if obseisty is a cause or a side effect of diabetes. But there really is little reason to pretend it's clear either way.
History is a pretty strong indication that it’s clear to me.
I find it exceptionally hard to believe populations at scale went from relatively “normal” weights to obese as the majority due to an emerging novel metabolic disorder. All within 1 to 2 generations.
Much simpler explanation is that diets and lifestyles changed leading towards obesity. Whether or not a metabolic disorder happened somewhere in the middle there seems irrelevant to me. It’s very clear to me that obesity causes the issues and not the other way around.
I’m open to thinking differently about it, I just find the evidence uncompelling as someone who was obese the majority of my adult life. Given the unique circumstances of how I grew up and then later experienced life, I’m quite confident obesity is primarily caused by lifestyle. Put simply - put yourself in a situation where obesity becomes easy to achieve and the majority of people will become obese.
Humans being what they are will of course have myriad of outliers to refute the point, but outliers are uninteresting to discuss in this context.
What does metformin have to do with it? I'm not obese, but I'm on metformin.
I think obesity just speeds up the onset, plenty of older skinny people with heart disease.
This is just my unqualified opinion to be clear
> Amy Bies was recovering in the hospital from injuries inflicted during a car accident in May 2007
When an article starts like this, I instantly close it and wait for proper sources. Anyway, the phrase "metabolic syndrome" has been gaining currency for the last few years. For those who don't want to read journal papers and meta-analyses, there are plenty of doctors and fitness coaches (on YouTube) who have made videos on how to get metabolic syndrome under control or even reverse it. And many of the doctors do a good job of filtering and summarizing the research.
You’ve got more patience than me. I read the title and decided I won’t bother reading the rest.
And then bragged about this.
Still more value than the headline/article!
Alongside all of these honest doctors and fitness coaches who espouse metabolic syndrome as the biggest health crisis of the 21st century there is a broad group of scammers and conmen who use the well backed science and literature to seed ground to push supplements and other crap. They seem to wrap the very basic medical truth of being overweight and inactive is horrific for your health in an onion of pseudoscience bullshit, so you buy the next best product high in "antioxidants" and "polyphenols"
The actual science is unimaginably boring. Do not be overweight on the BMI scale and do some moderate exercise for around 2 hours every week. This will drastically improve the health 1000x more than say the insane stuff that Brian Johnson is touting.
I hate modern fitness influencers and health wellness people in general. My head near about exploded when I saw a Tiktok from Jeff Nippard claiming that eggs increase your testosterone on a study with a sample size of FIVE PEOPLE.
> The actual science is unimaginably boring. Do not be overweight on the BMI scale and do some moderate exercise for around 2 hours every week.
Don't be depressed is also excellent advice for people with depression: if they can manage that, it improves their mood tremendously. Not catching colds also greatly reduces your chances of cold-like symptoms.
By which I mean, what you're saying is a truism, not medical advice. Keeping your BMI under control is a natural no-effort thing for some people, and a grueling lifelong struggle for others. Telling fat people to stop being fat is not "advice", it is exactly as helpful as telling sick people to stop being sick.
Absolutely, the issue of obesity is not just getting people to exercise more I 100% agree. The actual science of having someone diet, exercise and stick to that engagement is literally endlessly complicated and part of the reason why GLP-1 drugs are a big deal they can be given to almost anyone who meet the clinical criteria and see a drastic improvement in overall health and mortality.
That doesn't detach from the reality of the objectives, getting there is difficult for people and there is more research to be done.
FYI: None of my posts are medical advice and I am not a doctor
The term Metabolic Syndrome X has been around for more than a few years, unless nearly 40 is few (and I absolutely relate to that sentiment), just saying that concept was revved up in the 90s and of course has been an academic discussion going back to the early 20th century.
https://www.ahajournals.org/doi/10.1161/01.atv.0000111245.75...
https://pubmed.ncbi.nlm.nih.gov/3056758/
> When an article starts like this, I instantly close it
Why? You don't believe in car crashes or what?
I think they probably mean “article that’s meant to share research but mostly shares anecdotes”. It’s a common framing for this kind of thing though, so they probably have to close a lot of articles after the first sentence.
A friend of mine told me a few days ago that he thinks LLMs are already smarter than most humans. I agreed with him instantly.
Someone who wants to tell you something true doesn't lead their communication with emotional distraction. Kinda like how someone who is asking a real question doesn't disguise the question as an insult.
>Someone who wants to tell you something true doesn't lead their communication with emotional distraction.
This seems needlessly cynical. Someone can have multiple objectives in writing, to tell you facts and also to capture your attention or to convey an emotion and motivate you to action. Very little writing is done with a single purpose in mind. We don’t expect academics drafting research papers to eschew concerns about the impact the writing will have on their career for example.
Starting a story with an anecdote that humanizes the information is simply acknowledging the reality that people want more than just facts. If the latter was all they wanted, most of us would only read encyclopedias and textbooks.
In this case it really was just pointless distracting filler. The article would have been better without it. I reach for different books when I want drama or entertainment than when I want data and research. This article promises one thing and then clumsily shoves something else in randomly throughout. It really is obnoxious.
It's not emotional distraction, it establishes the reason the subject was getting blood tests, which is revealed later in the same sentence. If this is your level of reading stamina you must find yourself very poorly informed. Even a tweet would be too long for you.
it's just fucking annoying, really. just a really irritating, baity way to write
tldr
You will not build reading stamina or make yourself well informed with sappy stories. Learn some basic statistics and try reading research papers directly. "I have read more words" is a measure of only that, and nothing else. Maybe also a measure of the ability to not be able to separate wheat from chaff.
It's extremely lazy "writing".
Seems absolutely unnecessary, forced, immeasurably trite, off-puttingly boring, overused, so brazenly cliché that there has to be some kind of counter-intuitive selection going on, like with the email scammers that target those who are not immediately noticing the fraudulent intent.
... or simply our arrogance is showing, after all average minds discuss people, right?
How many major national magazines have published your superior articles?
How many major national magazines publish good articles? The inverted pyramid is from newspapers and bears resemblance to scientific publishing while magazines bear more resemblance to the human interest crap between events when presenting the Olympics. Perfectly fine I suppose but then it's nice if they don't get confused about appropriate subjects.
It is all interconnected, but I am unsure about the claim made. The reason is simple: there can be numerous disease types. Person A may have different genetics than Person B, as one example, so responses of a body may be different for that reason alone; then there is lifestyle choice, health, age and so forth. So I don't agree with the claim in the title here that all is one ailment - that makes no sense to me.
We are reasonably confident that diabetes causes heart and kidney disease. However the converse - if I have heart disease (or kidney) I also have diabetes is not true: there are many possible causes of heart or kidney disease.
This logic error is easy to make, and the headlines all too often imply it, but it isn't always true (sometimes it is).
I generally agree. It's all interconnected, and we could point to a singular cause, but to treat them all as one and of the same class of disease seems reductive and not useful.
Though, to be play devil's advocate for a second, it does seem that diabetes is typically where the symptoms start, and we do understand that diabetes is fundamentally metabolic and/or functional dysfunction in 1 or more of 7-ish different areas.
I think it's the level of perspective zoom + timing we take that makes the article's assertion either useful or not.
If we zoom out, while catching disease early on, and we address the metabolic conditions via lifestyle and/or certain drugs like GLP1, then we prevent the need to intervene on the kidney and cardiac front.
But if we zoom in to a specific issue, after disease has progressed a profound amount, a GLP1 intervention may be too little, too late.
Hopefully though, this may help the messaging to folks that if they are contending with metabolic disease that presents as diabetes, introducing lifestyle and pharma interventions early may be helpful on the larger epidemiological front.
HbA1c, or just diabetes as a binary variable, has been one of the main inputs into predicting heart attack risk for a long time.
The main marker of kidney function, eGFR, was added with the AHA/ACC's PREVENT equations in 2023.
I wrote a bit about the science behind heart risk calculators, and their various inputs like cholesterol, blood pressure, A1c, eGFR, and so on here: https://www.empirical.health/blog/heart-attack-risk-calculat...
There are 90 year olds with 60 years of diabetes and no complications and 40 year olds with 3 years of diabetes and devastating complications. Same for heart and kidney disease. They cannot be put in the same basket. No matter how much they try to push GLP-1's for everything under the sun, they are not.
If they find the drug of immortality, I am sure they will name every disease "partial death".
> The ties are so strong that in 2023 the American Heart Association grouped the conditions under one name: cardio-kidney-metabolic syndrome (CKM), with “metabolic syndrome” referring to diabetes and obesity.
Seems like this is mostly an extension of the previously existing label of metabolic syndrome, now including kidney. Ozempic is mentioned and I take that to mean obesity is the cause. But are some of these ailments like diabetes reversible?
I think it's saying that diabetes (T2 is reliably reversible) causes damage to the heart and kidney but sometimes the connection isn't made and they treat the kidney/heart symptoms without addressing the cause (T2D).
Interesting I didn’t realize T2 is reversible. How do people do that - some kind of drug? Or just weight loss?
Here's a protocol from a small study where 90+% reversed their T2D. https://link.springer.com/article/10.1186/s12916-025-04072-4
tl;dr it's everything you expect - home-cooked healthy meals, avoid sugary stuff, moderate exercise five days per week, etc